When the worst happens in the mountains it is important to have a plan. This article gives you some of the tools required to extract yourself and your party as safely as possible.

Sending for Help

When an incident takes place in the mountains of the UK, collect your thoughts - the emergency services will need to know what has happened, the nature of the injuries and the position of the incident. Read Box 1 and follow the instructions.

Mountain rescue in the UK region is well served by over seventy voluntary teams. They are equipped to a high standard and work closely with the Search and Rescue helicopters and Air Ambulance services. Consequently, only minor injuries should come within the scope of treatment and evacuation by the companions of the injured. The rule for all other cases is to make the casualty safe, to start first aid, and to send for mountain rescue.

The situation elsewhere in the world varies, and it is worth spending some time researching the availability and contact procedure for the rescue services before you travel. Member countries of the International Commission for Alpine Rescue (ICAR-CISA) have published a guide to International Emergency Telephone Codes & Mountain Rescue Services on their website (http://www.ikar-cisa.org). Remote destinations may have no organised rescue service and it may takes days or even longer for help to arrive. In many places, rescue and medical care can be very costly so adequate insurance is advisable.

More on calling for help abroad

General Treatment

While waiting for the emergency service, basic first-aid treatment should be given. Think ‘Safety, then follow ABC and DEF below (if appropriate)’.

Safety - Are you and the casualty safe from further danger?
If not, try to make yourselves safe either by moving or anchoring yourselves. Is the casualty responsive?

A - Is the casualty’s airway open?
If necessary, open it by a simple jaw thrust or chin lift. An open airway is essential; if the casualty is unconscious or semi-conscious, the tongue can fall back blocking the airway and cause death from asphyxia. After trauma (physical injury after an accident), gently stabilise the neck in the straight-line (neutral) position with your hands. Try to avoid further movement the neck. Continually check that the airway remains open, adjusting the casualty’s position as required.

B - Is the casualty breathing?
Look, feel and listen for breathing. Basic Life Support should be started, if you are trained, when the casualty is unconscious and shows no signs of breathing, and it can be continued until help arrives, and where there is a chance of recovery (lightning, drowning, heart attack). It is usually futile in casualties with internal injuries and is probably best to defer in cases of severe exposure/hypothermia until expert help is available. An unconscious but breathing casualty should be put in the ‘recovery position’ if possible. In cases involving trauma take care that the neck remains in a neutral position. Always, check the airway is still open.

C - Is the circulation adequate?
Stop any bleeding from wounds by elevation and direct pressure with dressings or clothing. The pressure needs to be applied continuously for at least 10 minutes. Internal bleeding should be suspected if the casualty has sustained blows to the chest or abdomen or broken thigh bone (femur). Loss of blood leads to shock; the casualty will be look white, feel cold and be sweating. The pulse may be rapid and the casualty anxious. Lay the casualty down and possibly raise the legs. The condition often deteriorates and all steps should be taken to facilitate the rapid arrival of the Mountain Rescue Team and, if possible, a helicopter. A record of the pulse rate and conscious level is very helpful.

D - Is the casualty disabled due to damage to head or spine?
Record the casualty's conscious level - Alert, responsive to voice, responsive to pain or unresponsive? Has the spine been damaged? If so, do not move the casualty unless essential for safety reasons. Maintain the head in the normal straight (neutral) position with your hands.

E – Prevent exposure
Prevent exposure (hypothermia) by sheltering the casualty from the wind and rain. Wrap them in as many layers of clothing as possible and encased in a 'poly bag' or other impermeable barrier. Do not forget to insulate the head and underneath the casualty. Even mild hypothermia worsens the outcome of many injuries. See Box 2 for more detail.

F – Check for fractures?
If present, immobilise the limb by the simplest method available. In the case of the arm, pad it and bandage it to the chest, and in the case of the leg, pad it and bandage it to the other leg.

Further points to consider in the UK
Large, organised groups should bear in mind that the Mountain Rescue Teams are a finite resource and it is wrong to assume their availability.

A helicopter may arrive before the Mountain Rescue Team. Extinguish all flames and secure all equipment. To attract the attention of the helicopter stand facing it with both arms up in the air making a Y shape. The downdraught can knock you over, so make sure you are in a safe position. Do not approach the helicopter until clearly signalled to do so by the pilot.

Prevention is better than First Aid! Most injuries are lower leg sprains and fractures; appropriate footwear is important. The majority of climbers killed in the UK as a result of a climbing accident die from a head injury. A helmet, whilst not being 100% effective, can make the difference between living and dying. GPS systems, whilst being useful, are no substitute for carrying a map and compass, and knowing how to use them.

The routine carrying of a suitable head-torch would save many needless call-outs. And finally, whilst mobile phones can be very useful in emergencies, any temptation to use them in the hills to call the emergency services in non-emergency circumstances should be resisted. If you are not sure whether it is an emergency or not, please investigate a little yourself first before reaching for your phone.

Your mountain rescuers are unpaid volunteers and rely on charitable contributions. Your consideration and a ‘Thank you’ go a long way to ensure the service continues. For further information, see the Mountain Rescue Council and Mountain Rescue Committee of Scotland websites (http://www.mountain.rescue.org.uk/ and http://www.mrcofs.org/)

Dr John Ellerton is a Mountain Rescue Doctor and originally wrote this piece for the Harvey/BMC series of maps.

Emergency signal: for alerting other parties or directing a mountain rescue team to your location – six blasts on the whistle (or six torch flashes) repeated every minute.

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